Hypothyroidism
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| A deficiency of thyroid hormone that causes general slowing of the metabolic rate. | hypothyroidism
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| Classifications of hypothyroidism | primary hypothyroidism and secondary hypothyroidism
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| Is caused by destruction of thyroid tissue or defective hormone synthesis. | primary hypothyroidism
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| Is caused by pituitary disease with decreased TSH secretion or hypothalamic dysfunction w/decreased thyrotropin-releasing hormone (TRH) secretion. | secondary hypothyroidism
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| Hypothyroidism may also be transient and related to what? | Thyroiditis or discontinuance of thyroid hormone therapy.
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| What is the most common cause of hypothyroidism worldwide? | iodine deficiency
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| What is the most common cause of primary hypothyroidism in the U.S.? | atrophy of the thyroid gland
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| In hypothyroidism, atrophy of the thyroid gland is the end result of what? | Hashimoto's thyroiditis or Graves' disease - these autoimmune disease destroy the thyroid gland
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| Hypothyroidism may also develop as a result of what treatment? | Treatment for hyperthyroidism specifically the surgical removal of the thyroid gland or RAI therapy.
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| What drugs can cause hypothyroidism? | amiodarone (Cordarone) contains iodine and lithium which blocks hormone production
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| What is it called when hypothyroidism develops in infancy causing thyroid hormone deficiencies during fetal or early neonatal life. | cretinism
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| Hypothyroidism has systemic effects characterized by what? | a slowing of body processes
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| Manifestations can vary depending on what? | The severity and the duration of thyroid deficiency, as well as the patient's age at the onset of the deficiency.
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| The onset of symptoms may occur over months to years unless hypothyroidism occurs after what? | A thyroidectomy, thyroid ablation, or during treatment with antithyroid drugs.
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| CM of hypothyroidism | Dec. cardiac contractility & CO; angina, HF, MI; anemia; cobalamin, iron, folate deficiencies causing easy bruising; inc serum cholesterol & triglycerides; low exercise tolerance, SOB on exertion; fatigue, lethargy, impaired memory, mental changes
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| Hypothyroidism is associated w/decreased cardiac contractility and decreased cardiac output, so the patient may experience what? | low exercise tolerance and SOB on exertion
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| Anemia is a common feature of hypothyroidism. What occurs with erythropoietin levels and oxygen demand? | Erythropoietin levels may be low or normal. Because the metabolic rate is lower, oxygen demand is reduced.
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| Increased serum cholesterol and triglyceride levels and the accumulation of mucopolysaccharides in the intima of small blood vessels can result in what? | coronary atherosclerosis
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| What occurs with the respiratory system in hypothyroidism? | Low exercise tolerance and SOB on exertion
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| What occurs with the neurologic system in hypothyroidism? | Pt is often fatigued, lethargic, have personality/mental changes including impaired memory, slowed speech, dec. initiative, & somnolence (appear sleepy/drowsy), appear depressed
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| CM of the GI system in hypothyroidism | Decreased appetitie, N/V, weight gain, constipation, distended abdomen, enlarged, scaly tongue, Celiac disease
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| CM of the Integumentary system in hypothyroidism | Dry, thick, inelastic, cold skin; thick, brittle nails; dry, sparse, coarse hair; poor turgor of mucosa; generalized interstitial edema; puffy face; decreased sweating; pallor
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| CM of the Musculoskeletal system in hypothyroidism | fatigue, weakness; muscular aches & pains; slow movements; arthralgia
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| CM of the Reproductive System in hypothyroidism | Prolonged menstrual periods or amenorrhea; decreased libido, infertility
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| Other CM of hypothyroidism | Increased susceptibility to infection; increased sensitivity to opioids, barbiturates, anesthesai; intolerance to cold; decreased hearing; sleepiness; goiter
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| Patients with severe long-standing hypothyroidism may display this type of physical appearance of the skin and subcutaneous tissues. | myxedema
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| Due to the accumulation of hydrophilic mucopolysaccarides in the dermis and other tissues. | myxedema
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| What does myxedema cause? | Puffiness, facial and periorbital edema, and a masklike affect
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| What is myxedema coma? | A medical emergency due to the mental sluggishness, drowsiness, & lethargy of hypothyroidism it may progress gradually or suddenly to a notable impairment of consciousness or coma.
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| What can cause myxedema coma? | Infection, drugs (especially opioids, tranquilizers, & barbiturates), exposure to cold, & trauma
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| What are the characteristics of myxedema? | subnormal temperature, hypotension, & hypoventilation
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| In myxedema coma, cardivascular collapse can result from what? | hypoventilation, hyponatremia, hypoglycemia, and lactic acidosis
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| What must be done for a patient to survive a myxedema coma? | Vital functions must be supported, and IV thyroid hormone replacement must be administered.
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| What are the most common and reliabel lab tests for thyroid function? | TSH & free T4
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| TSH and free T4 values correlated with this can confirm the diagnosis of hypothyroidism. | Symptoms gathered from the history and physical examination
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| Serum TSH levels help to determine what in hypothyroidism? | the cause of
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| When serum TSH is high, then the defect is in the what? | the thyroid
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| When serum TSH is low then the defect is in the what? | the pituitary or hypothalamus
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| The presence these suggests an autoimmune origin of the hyothyroidism. | thyroid antibodies
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| What are some abnormal lab findings in hypothyroidism? | Increased cholesterol, increased triglycerides, increased creatine kinase, decreased RBCs (anemia)
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| What is the treatment goal for a patient with hypothyroidism? | Restoration of a euthyroid state as safely and rapidly as possible with hormone therapy.
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| What type of diet should patients with hypothyroidism have? | A low calorie diet to promote weight loss or prevent weight gain.
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| What is the drug of choice to treat hypothyroidism? | levothyroxine (Synthroid)
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| When thyroid hormone therapy is initiated (levothyroxine), why is it important that the initial dosages are low? | To avoid increases in resting heart rate and blood pressure.
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| In a young and otherwise healthy patient, the maintenance replacement dose of levothyroxine is adjusted according to what? | the patient's response and lab findings
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| In a hypothyroidism patient w/compromised cardiac status, what should you monitor for? | Monitor for cadiovascular SE (chest pain, dysrhythmias), weight loss, nervousness, tremors, insomnia; monitor HR, report pulse >100 bpm or an irregular beat.
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| Hypothyroidism patients with compromised cardiac status need to be carefully monitored when the dosage is started and adjusted. Why? | The usual dose may increase myocardial oxygen demand. The increased oxygen demand may cause angina and cardiac dysrhthmias.
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| In a patient with no side effects from the levothyroxine therapy, what should be done to the dose at 4-6 week intervals? | increased
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| It is important that the patient regularly take replacement medication because what is usually required? | lifelong thyroid therapy
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| When assessing a patient with hypothyroidism what important information from the patient's health history should be obtained? | Previous hx of hyperthyroidism & tx w/antithyroid medications, radioactive iodine, or surgery. Ask the pt about prescribed iodine containing meds & changes in appetite, weight, activity level, speech, memory, & skin such as inc. dryness or thickening.
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| During the physical examination of a patient suspected of hypothyroidism what should you assess? | Assess for cold intolerance, constipation, and signs of depression. Assess HR, tenderness over the thyroid gland, and edema in the extremities and face.
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| Most individuals w/hypothyroidism are treated on an outpatient basis except for the patients that develop this. What kind of care would these patients need? | Myxedema coma pts would require acute nursing care often in an ICU setting.
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| What are some nursing interventions for myxedema coma? | Mechanical resp. support & cardiac monitoring are freq. necessary. Administer thyroid hormone therapy & all other meds IV b/c ileus may be present. Monitor the core temp. b/c hypothermia often occurs.
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| What are some acute interventions for hypothyroidism? | skin care: use soap gently, moisturize freq. to prevent skin brkdwn., frq changes in position & low pressure mattress; Monitor vitals, weight, I&O, edema; cardiovascular response to hormone; energy levels; mental alertness
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| These are used to determine continuing levothyroxine treatment. | the patient's neurologic status and free T4 levels
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| When should thyroid hormones be taken? | in the morning before food
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| Patient teaching for hypothyroidism | Regular f/u care; don't switch brands of hormones; comfortable, warm environment; measures to prevent skin breakdown; emphasize need for warm environment; avoid seadtives or use lowest dose; measures to minimize constipation, avoid enemas
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| If sedatives must be used, the lowest dose possible should be given. What should the caregiver closely monitor? | mental status, LOC, and respirations
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| What suggestions would you give a patient to help minimize constipation? | Gradual increase in activity and exercise. Increased fiber in diet. Use of stool softeners. Regular bowel elimination time.
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| Why should the patient avoid using enemas? | They produce vagal stimulation which can be hazardous if cardiac disease is present.
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| What are the expected outcomes for hypothyroidism? | Have relief from symptoms. Maintain a euthyroid states AEB normal thyroid hormone & TSH levels. Avoid complications. Adhere to lifelong therapy.
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